title: Identification of adult septic patients in the prehospital setting: a comparison of two screening tools and clinical judgment.
abstract: BACKGROUND
  Timely identification and treatment of sepsis is crucial for patient outcome. The aim of this study was to compare two previously unvalidated prehospital sepsis screening tools with clinical judgment by emergency medical services (EMS) personnel with respect to identification of septic patients.
  
  
  METHODS
  We carried out a retrospective cross-sectional study of 353 adult patients, transported by the EMS, with a hospital discharge International Classification of Diseases code consistent with sepsis. We analyzed EMS records for the identification of sepsis according to two screening tools and clinical judgment by EMS providers. The Robson screening tool includes temperature, heart rate, respiratory rate, altered mental status, plasma glucose, and a history suggestive of a new infection. BAS 90-30-90 refers to the vital signs: oxygen saturation, respiratory rate, and systolic blood pressure. McNemar's two related samples test was used to compare the sensitivity of the two screening tools with the sensitivity of clinical judgment.
  
  
  RESULTS
  The Robson screening tool had a sensitivity of 75% (18 out of 24 patients for whom all parameters were documented, P<0.001, as compared with clinical judgment). BAS 90-30-90 had a sensitivity of 43% (76 out of 175 patients, P<0.001). EMS personnel documented suspected sepsis in 42 out of 353 (12%) patients with sepsis.
  
  
  CONCLUSIONS
  The Robson screening tool had a sensitivity superior to both BAS 90-30-90 and clinical judgment. This supports our hypothesis that the implementation of a screening tool could lead to increased prehospital identification of sepsis, which may enable a more timely treatment of these patients.
authors.affiliation: aDepartment of Clinical Research and Education, Karolinska Institutet, Södersjukhuset bSection of Emergency Medicine, Södersjukhuset cFisksätra Vårdcentral, Saltsjöbaden, Sweden.
authors.forename: Ulrika M
authors.initials: UM
authors.lastname: Wallgren
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Alexandra E V
authors.initials: AE
authors.lastname: Svensson
authors.forename: Lisa
authors.initials: L
authors.lastname: Kurland
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000503:physiopathology; D055986:Vital Signs / Q000502:physiology